Agent Inspection Request

Lifetime strives to provide the best possible service to our Insurance Agency partners and their customers. Please complete this form with as much information as you can provide. It is okay if you are unable to fill out every field but the more we know, the better we can serve you. Thank you. If you have any questions you can always reach us at 314-800-0426. 

* Required

Email address *

Agency Representative *

Who is to receive inspection results (if different from above)

INSURED CLIENT INFORMATION

Property Owner First and Last Name *

Property Owner Phone Number *

Property Owner Email Address

Property Address *
Please provide full street address including city, state and zip

What is the approximate age of the roof?

Insurance Carrier Name *

When was this policy written?
If less then 2 years old

Wind/Hail Deductible amount

Is this a replacement cost policy?
YESNO

Does this policy have Law and Ordinance coverage?
YESNO

What stage of the claim process is this customer in?

When do they suspect the damage occurred?
To be confirmed or adjusted upon inspection results

Please explain clients concerns or requests

A copy of your responses will be emailed to the address you provided.